Gallstones – The Unmitigated Gall of It All!

gallstone

Though you may have never experienced it, you might have heard that the pain experienced by those who have symptomatic gallstones ranges from discomfort to excruciating. In the U.S. alone, there are approximately 20 million people with gallstone disease, a conglomerate of disorders that typically refers to patients who either develop pain from gallstone obstruction or an infection of the gallbladder. Patients with this condition will usually manifest severe abdominal pain after consuming a greasy meal, and generally, this event triggers them to seek a medical evaluation. Luckily, surgical treatment of gallstone disease is curative, and oftentimes simple to perform. However, as with any surgery, it’s best if the patient can have this done as an elective procedure rather than as an emergency operation. Oftentimes what seems like normal abdominal or bowel pain may be an indication of the symptoms of gallstone disease. Fortunately, familiarization with the classic presentation of gallstone disease routinely leads to a prompt assessment and more effortless treatment. Logically, early treatment of this disorder will lead to a reduced risk of major complications.

The gallbladder organ is located in the right upper abdomen and its function is to store and release bile, a substance produced in the liver that aids in the breakdown and absorption of fats. When a fatty meal enters the stomach, the body dispenses cholecystokinin, a hormone that signals the gallbladder to begin the excretion of bile. The remaining bile will be reabsorbed into the bloodstream via the intestinal walls. However, if a patient has a gallstone that blocks the duct, the bile will remain within the gallbladder, resulting in an increase in the internal pressure. This explains why patients develop the colicky abdominal pain. In addition to this, patients will also complain of back pain, nausea, and vomiting. If the blockage is prolonged, bacteria will enter and infect the gallbladder. Patients with an infection will have all of the aforementioned symptoms, but their pain is usually sustained and will last longer than four hours. The diagnosis of gallbladder disease is made with a combination of the clinical presentation and an ultrasound. In a subset of patients, other imaging modalities such as a HIDA scan (specialized nuclear analysis) might be necessary. The treatment involves medications for pain control, antibiotics (in the case of infection), and surgery. All patients with symptomatic gallstones will require gallbladder removal, and although it’s generally a straightforward procedure, complications such as abscesses, bowel injury, or a bile leak may ensue. It’s important to note that although the gallbladder is a valuable organ, it’s not essential.

There are a variety of risk factors that can predispose patients to gallstones, which include: female gender, pregnancy, obesity, rapid weight loss, medications (e.g. birth control pills), diabetes, and being older than 40 years of age. Scientists have also reported several protective elements, such as the use of statin medications (prescribed for high cholesterol) and the intake of vegetable proteins and nuts. Patients who develop frequent abdominal pain after eating fatty foods should mention it to their primary care doctors, given that they may be experiencing symptoms of gallstone disease. In a fair number of cases, patients have incorrectly attributed their abdominal pain to their cholesterol-ridden meal, without realizing that their recurrent pain was due to gallstone disease all along.

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